The list of services that require advance notification and prior authorization is the same. The process for providing notification and submitting a prior authorization request is the same. Services that require prior authorization require a clinical coverage review based on medical necessity.
View the most current and complete advance notification requirements, including procedure codes and associated services, at uhcprovider.com/priorauth > Advance Notification and Plan Requirement Resources.
If you need a paper copy of the requirements, contact your UnitedHealthcare Network Management representative or provider advocate at uhcprovider.com > Contact Us.
We recommend that you submit advance notification with supporting documentation as soon as possible, but at least 2 weeks before the planned service (unless the Advance Notification Requirements states otherwise). Following a facility discharge, advance notification for home health services and DME is required within 48 hours after the start of service.
After submitting your request, you get a service reference number. This is not an authorization. When we make a coverage determination, we issue it under this reference number.
It may take up to 15 calendar days (14 calendar days for standard MA requests and 72 hours for expedited requests) for us to make a decision. We may extend this time if we need additional information. Submitting requests through the Prior Authorization and Notification tool in the UnitedHealthcare Provider Portal assists in timely decisions.
We prioritize case reviews based on:
If you require an expedited review, call the number listed on the member’s ID card. You must explain the clinical urgency. You will need to provide required clinical information the same day as your request.
We expedite reviews upon request when the member’s condition:
DME provides therapeutic benefits to a member because of certain medical conditions and/or illnesses. DME consists of items which are:
Refer to our Commercial Coverage Determination Guideline for DME, Orthotics, Medical Supplies and Repairs/Replacements at uhcprovider.com/policies > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans or our Medicare Advantage Coverage Summary for DME, Prosthetics, Corrective Appliances/Orthotics and Medical Supplies on uhcprovider.com/policies > Medicare Advantage Policies > Coverage Summaries for Medicare Advantage Plans.